Opioid Stewardship Pledge for Pain Management

Opioid Stewardship Pledge for Pain Management Clinics

Responsible opioid prescribing is one of the most critical commitments a pain management clinic can make. This Opioid Stewardship Pledge template helps clinics formalize their commitment to evidence-based prescribing guidelines, alternative therapy integration, and comprehensive addiction screening protocols.

Whether you're establishing a new pain management practice or strengthening existing protocols, this template provides a structured framework for documenting your clinic's dedication to patient safety and comprehensive pain care.

Why Use This Template?

Pain management clinics face unique challenges in balancing effective pain relief with the risks of opioid dependence. This pledge form helps your practice:

• Demonstrate clinical excellence by committing to CDC prescribing guidelines and best practices
• Document comprehensive protocols for patient screening, monitoring, and alternative therapy offerings
• Build patient trust by showing transparency in your approach to opioid management
• Align team members around shared stewardship principles and treatment philosophies
• Support accreditation and compliance requirements for pain management standards

Paperform Makes Healthcare Commitments Simple

With Paperform's conditional logic, you can create different pledge pathways for individual providers versus entire clinics, capture specific prescribing protocols, and even collect eSignatures through Papersign to formalize the commitment.

Connect your completed pledges to Stepper to automate follow-up workflows—like scheduling annual pledge renewals, sending educational resources on alternative therapies, or creating accountability check-ins for prescribing pattern reviews.

This template is ideal for pain management clinics, integrated health systems, addiction medicine programs, healthcare coalitions, and medical associations working to promote responsible opioid stewardship across their networks.